Provider Demographics
NPI:1992144331
Name:NORMAN, KEITH WAYNE (NP)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WAYNE
Last Name:NORMAN
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:401 YOUNGSVILLE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5173
Mailing Address - Country:US
Mailing Address - Phone:337-330-8660
Mailing Address - Fax:337-417-9909
Practice Address - Street 1:431 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3042
Practice Address - Country:US
Practice Address - Phone:337-806-9913
Practice Address - Fax:337-703-0283
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
LA64455-7388363LF0000X
LAAP07388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily